As we’ve promised in our previous posts; we’ve finished analyzing state vaccine legislation data from 2019-present. Efforts to collect data from the 2024 legislative session are ongoing.

This means that we can now compare insights about the state of anti-vaccine legislating across US state legislatures in the 2023 legislative session (the subject of our previous posts) to pre-pandemic trends.

In this report, we summarize results from a new academic paper (currently a preprint posted to the Open Science Framework) that offers new insights into how vaccine-related legislative activity has changed since the outset of the COVID-19 pandemic. We also offer some analyses not found in that paper.

Put simply, our work finds that COVID-19 Fundamentally Changed Vaccine Policymaking in the US.

A few top line findings:

Vaccine-Related Legislation Spiked Following COVID-19. Whereas state legislatures introduced just 399 vaccine-related bills in the 2019 legislative session, that number skyrocketed to 1,200 bills in the first legislative session following the onset of COVID-19.

Anti-Vaccine Legislation Was Rare Before COVID-19, but It is Common Today. Prior to the COVID-19 pandemic, legislation that was anti-vaccine in focus comprised under one quarter of all vaccine-related bills introduced in state legislatures (about 24% in 2019). That figure more than doubled by 2022 to over 56% of all bills introduced. Over 300 anti-vaccine bills have been introduced every year since 2021.

Republican Lawmakers Accounted for Most Anti-Vaccine Legislating Prior to and Throughout the COVID-19 Pandemic. Although Republican lawmakers were responsible for most anti-vaccine legislating prior to the COVID-19 pandemic (nearly 60% in 2019), they are responsible for nearly all of it today (nearly 90% of all anti-vaccine bills introduced from 2021–2023).

As always, please refer to our previous reports and technical appendix for additional information about how we collect and code SVPP data.

Vaccine-Related Legislative Activity Spiked Following the Onset of COVID-19

Vaccine policymaking is, fundamentally, a state-level responsibility in the United States. As we might expect, SVPP data suggest that the onset of the COVID-19 pandemic had a powerful impact the legislative activity of state policymakers across the US.

Prior to the onset of COVID-19, state legislatures introduced just 399 vaccine-related bills in 2019. That picture changed dramatically during the pandemic. By 2021, the number of vaccine-related bills tripled to 1,200 bill introductions across state legislatures. These data provide evidence consistent with the idea that state lawmakers were responding to changing public health risks by introducing more legislation related to vaccination.

Although vaccine legislating has not returned to the levels that we observed in the immediate aftermath of the COVID-19 pandemic, it remains more common today than in the pre-pandemic period. Both the 2022 (N = 757 bills) and 2023 (N = 809 bills) legislative sessions saw more vaccine-related legislating than the 2019 session.

Anti-Vaccine Legislation Was Rare Before COVID-19; Commonplace Today

Reminder: SVPP relies on a team of human coders to determine whether vaccine are pro or anti-vaccine in focus. Please consult our working paper for more detailed information on how we determine whether bills promote or oppose vaccination.

The rise in vaccine-related legislating in the post-pandemic era hasn’t all been focused on vaccine promotion. SVPP data document an asymmetric increase in anti-vaccine legislation following the onset of COVID-19.

Figure 1 illustrates this trend by plotting the total number of vaccine related bills introduced in state legislatures from 2019–2023 that are pro-vaccine, anti-vaccine, or neither pro nor anti-vaccine in focus (left-hand panel). It also presents the relative proportion of bills that are pro vs. anti-vaccine in focus over time (right-hand panel).

Figure 1. The Prevalence of Pro and Anti-Vaccine Legislation Introduced Across State Legislatures from 2019–2023.

Prior to the onset of COVID-19 most vaccine-related bills tended to focus on vaccine promotion. SVPP data suggests that just 24% (97 bills) introduced in 2019 were anti-vaccine in focus. That number nearly doubled to 46% in 2021 (557 bills), and 56% (425 bills) of bill introductions in 2022.

As we have detailed in our previous reports, anti-vaccine legislating remains common today, and dozens of anti-vaccine bills have been signed into law in 2023 alone. Please refer to our previous press releases for additional information.

Republican Lawmakers Accounted for Most Anti-Vaccine Legislating Prior to and Throughout the COVID-19 Pandemic.

The rise in anti-vaccine legislating following the onset of COVID-19 (documented above) is primarily attributable to the legislative actions of Republican state lawmakers.

Republican elites in the news media and federal government made an effort to cast doubt on the safety of COVID-19 vaccination, and to portray vaccine mandates as an infringement on individual liberty. Correspondingly, members of the American public came to hold more negative views toward vaccinating as the pandemic wore on.

As we here at SVPP and others have argued, vaccine politicization is problematic, as it might provide lawmakers with an incentive to introduce politically-motivated legislation. Consistent with the idea that the COVID-19 pandemic served as a catalyst for vaccine politicization, state lawmakers appear to be responding to elite rhetoric and public opinion.

SVPP data suggest that vaccine politicization in the federal government, mass media, and American public is indeed reflected in the actions of state lawmakers. Figure 2 visualizes this trend by plotting the total number (left-hand panel) and relative proportion (right-hand panel) of anti-vaccine legislation introduced by Republicans (in red), Democrats (in blue), or third party and/or bipartisan groups of lawmakers (in purple).

Figure 2. Partisan Trends in Anti-Vaccine Leiglsating from 2019–2023.

We find that, prior to the onset of COVID-19, Republican lawmakers accounted for just under 60% of anti-vaccine legislating. Republicans were responsible for most — but certainly not all — anti-vaccine legislating at that time.

Partisan trends in anti-vaccine legislating changed dramatically, however, during the COVID-19 pandemic. By 2021, Republicans accounted for nearly 90% of all vaccine-related bills introduced across state legislatures; a figure that has held remarkably steady since the immediate aftermath of the COVID-19 pandemic.

Additionally, and further consistent with the idea that concerns about individual liberty may be motivating Republican lawmakers to take anti-vaccine policy action, SVPP data allow us to track how many anti-vaccine bills specifically make an effort to oppose workplace vaccine mandates and/or vaccine mandates in educational settings.

Figure 3 plots the total number of bills introduced in each legislative cycle that were both anti-vaccine in focus and pertained specifically to expressing opposition to vaccine mandates. There, we show that SVPP classified just 76 bills as opposing vaccine mandates in various employment or educational settings in 2019. That number ballooned to 405 in 2021, and has remained at levels more than triple that of 2019 ever since.

Figure 3. The Prevalence of Anti-Mandate Legislation Introduced in State Legislatures from 2019–2023.

COVID-19 Fundamentally Changed Vaccine Legislating in the US. So… What’s Next?

Thus, SVPP data paint a very clear picture about the state of vaccine-related policymaking in a post-pandemic world. The COVID-19 pandemic fundamentally changed how state lawmakers legislate, when it comes to vaccine-related issues.

We’ll leave questions about what’s next for the future of public health to future press releases. For now, we wanted to provide a brief update about where SVPP is heading. We’ll be conducting additional data collection, coding, and analysis for the 2024 legislative session in the coming months. Additionally, we’ll be looking to extend our data collection efforts back in time to the mid-1980s to provide insights about long-term trends in vaccine-related policymaking over the past several decades. We plan to prioritize the former data collection effort, while making steady progress on the latter.

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SVPP consists of Dr. Matt Motta (mmotta@bu.edu) and Dr. Tim Callaghan (timcal@bu.edu). Please contact Dr. Motta with technical questions about this report. Please reach out to us directly for press inquires.

SVPP is funded by a seed grant from the Boston University School of Public Health. We thank Boston University for their generous support. Coders for this SVPP press release include MPH student Emma Mears, and BUSPH MPH alumni Ali Rivera and Juhi Shahani. Rachel Ma and Grace Connors are our current SVPP Practicum Researchers. This report is made possible by their hard work and dedication to the project, and for that we are immensely thankful.

Some of the bills that we will report on throughout this series have only recently been introduced for consideration in state legislatures across the US. Others are making their way through the legislative process. And while some of the bills we profile have been rejected (but, we fear, may return again in future legislative sessions), others have already been introduced into law.

For more information on the total number of anti-vaccine bills introduced, rejected, and passed into law across state legislatures in 2023, please refer to our second report: available here.

Here’s what we’re watching and thinking about, right now:

Tennessee Senate Bill 369 — Stigmatizing mRNA-based Vaccines & Stripping Power from Public Health Experts to Order Livestock Vaccination

Bill Title & Text.

Title: “AN ACT to amend Tennessee Code Annotated, Title 44; Title 47, Chapter 18 and Title 53, relative to meat.”

Text: https://open.pluralpolicy.com/tn/bills/113/SB369/

Current Status.

Passed Senate; Introduced into the House (no action taken in the House).

What the bill does.

1. “Specifies that meat may be labeled as being free of mRNA vaccine if the animals from which the meat was derived were not administered an mRNA vaccine”
2. “Removes authorization for the commissioner of agriculture and the state veterinarian to order vaccination of livestock”
3. “Specifies that there is no state legal requirement to vaccinate livestock.”

Why We’re Concerned.

In the middle of one of the deadliest outbreaks of avian influenza (H5N1) in recent memory — which has seen unprecedented levels of cross-species spillover, transmission to humans, and (perhaps most concerningly) possible human-to-human transmission — Representative Niceley (R-TN) introduced legislation that would strip credentialed veterinary experts in Tennessee from ordering livestock vaccination. This is alarming, as livestock vaccination could represent a powerful tool in the fight against deadly forms of avian flu and other diseases that pose major public health risks to both animal and human populations.

Additionally, the bill allows food manufacturers to label meat as being unvaccinated with vaccines that use mRNA technology (like the Pfizer and Moderna vaccines used to prevent COVID-19 transmission in humans). Currently, most commonly administered livestock vaccines do not use mRNA technology, and the only approved mRNA vaccine for use in livestock is a swine flu vaccine. However, the safety and efficacy of mRNA-based avian flu vaccines (among others) are currently undergoing scientific evaluation.

Labeling meat products as unvaccinated with mRNA technology risks further stigmatizing public perceptions of mRNA vaccine safety if people come to view meat unvaccinated with mRNA technology as more safe than meat vaccinated using mRNA technology. This is problematic, as public concern about mRNA technology has been shown to motivate vaccine hesitancy. Additionally, mRNA labeling may be misleading, as only pork products (and not other livestock) have the opportunity to receive mRNA based vaccines currently in the first place.

Luckily, although this Bill passed through the Tennessee Senate, it appears to have received no further action in the Tennessee House for the remainder of the 2023 calendar year. But, the SVPP team is worried about the negative public health consequences of legislation like this. If reintroduced in Tennessee, or elsewhere, the bill would not only sow doubt about mRNA vaccine technology, but also take away the power of licensed veterinary experts to help reign in infectious disease threats that not only threaten our food supply, but pose grave public health risks for humans more generally.

Written by: Matt Motta

Texas SB 29 — An “Anti-Mandate” Vaccine Mandate

Title: Relating to prohibited governmental entity implementation or enforcement of a vaccine mandate, mask requirement, or private business or school closure to prevent the spread of COVID-19.

Text: https://open.pluralpolicy.com/tx/bills/88/SB29/

What the bill does.

Restricts governmental entities’ abilities to:

1. “implement, order, or otherwise impose a mandate requiring a person to wear a face mask or other face covering to prevent the spread of COVID-19.”
2. “implement, order, or otherwise impose a mandate requiring a person to be vaccinated against COVID-19.”
3. “implement, order, or otherwise impose a mandate requiring the closure of a private business, public school, open-enrollment charter school, or private school to prevent the spread of COVID-19.”

Current Status.

Signed into law.

Why We’re Concerned.

SB29, which was passed into law in 2023 in Texas, strips government health authorities ability to take action to protect Texans from infection with COVID-19.

It’s important to note that the law is limited in scope to vaccine mandates related to stopping the spread of COVID-19, and carves out exceptions for communal living centers and prisons. Still, the SVPP fears that “anti-mandate mandates” like this one — and similar bills signed into law in other states — not only hamper our ability to respond ongoing public health threats related to the COVID-19 pandemic, but establish a legal precedent for empowering states to override public health authorities in responding to infectious disease outbreaks.

SB29 is also an important reminder that while most anti-vaccine legislation is not ultimately enacted, some bills are passed into law.

Written by: Matt Motta

Indiana SB4 — Public Health Commission

Title: AN ACT to amend the Indiana Code concerning health.

Text: https://open.pluralpolicy.com/in/bills/2023/SB4/

Current Status.

Signed into law.

What the bill does.

1. Require that before administering a vaccine, a local health department must provide education on:

· The immunization data registry, including information concerning exclusion from the registry

· The Vaccine Adverse Event Reporting System maintained by the federal Centers for Disease Control and Prevention and the federal Food and Drug Administration

· The Countermeasures Injury Compensation Program

· The National Vaccine Injury Compensation Program

2. Makes various other changes to state provisions tied to public health in the state

Why We’re Concerned.

Within a much broader bill about public health, SB 4 — which was passed into law by Indiana in 2023, requires that individuals in the state be educated on how to be excluded from the immunization data registry as well as about programs designed to allow individuals to report and be compensated for vaccine injury. While we believe that education on vaccination broadly is a good thing, the consequences of this new bill could serve to reduce vaccine uptake. Highlighting vaccine injury right before vaccination could serve to sow doubt among some individuals about the safety of vaccines, potentially leading to reduced vaccine uptake.

Simultaneously, highlighting how to exclude yourself from the immunization registry could reduce the quality and accuracy of immunization data collected, with important consequences for vaccination and disease surveillance.

Ultimately, while the SVPP team is supportive of efforts to educate individuals about vaccines, including about what to do in the case of vaccine injury, it must be balanced against providing individuals with information about the safety and effectiveness of vaccines. Without providing this further context, SB 4 could ultimately reduce vaccine uptake and reduce data quality.

Written by: Timothy Callaghan

Idaho S 1130 — The ‘Coronavirus Stop Act’

Title: Relating to Coronavirus; providing legislative intent; amending TITLE 73, Idaho Code, by the addition of a new chapter 5, Title 73, Idaho Code, to provide a short title, to define terms, to prohibit Coronavirus vaccination requirements, and to provide for severability; and declaring an emergency.

Text: https://open.pluralpolicy.com/id/bills/2023/S1130/

Current Status.

Signed into law.

What the bill does.

1. Frame the COVID-19 vaccine as a relatively new medical development, noting that the decision to receive such a vaccine is a personal and individual decision. The legislation notes that individuals should not be treated differently or discriminated against because they have not been vaccinated.

2. Mandates that any business in the state of Idaho cannot refuse to provide any service, product, admission, or transportation to a person because they have not been vaccinated against COVID-19.

3. Mandates that any business entity doing business in Idaho cannot require a COVID-19 vaccine as a term of employment, with limited exceptions.

4. Places limits on the ability of the state, counties, or local governments from requiring COVID-19 vaccination or using COVID-19 vaccination status as a condition for services.

Why We’re Concerned.

S 1130, which was passed into law in 2023 in Idaho, prevents businesses in the state from using COVID-19 vaccination status as a condition of employment or to determine the allocation of goods and services. It also limits the ability of state and local entities from using COVID-19 vaccination status as a condition for services.

While COVID-19 vaccine mandates are a controversial topic, mandates are an effective way to ensure widespread vaccination, helping to reduce the burden of disease from COVID-19. By preventing not just governmental entities, but also private businesses from mandating vaccination, the state is limiting the possibility of mandates being implemented. This decision takes the choice of mandating vaccination out of the hands of private companies as well as political leaders throughout the state, potentially resulting in reduced COVID-19 vaccine uptake.

S 1130 serves as an important example of state efforts to block entities from requiring COVID-19 vaccination.

Written by: Timothy Callaghan

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SVPP consists of Dr. Matt Motta (mmotta@bu.edu) and Dr. Tim Callaghan (timcal@bu.edu). Please contact Dr. Motta with technical questions about this report. Please reach out to us directly for press inquires.

SVPP is funded by a seed grant from the Boston University School of Public Health. We thank Boston University for their generous support. Coders for SVPP include MPH student Emma Mears, and BUSPH MPH alumnus Ali Rivera. This report is made possible by their hard work and dedication to the project, and for that we are immensely thankful.

As we noted in our previously, SVPP is still collecting and analyzing data that will allow us to make over-time comparisons between anti-vaccine legislating in 2023 and previous years. That will allow us to assess whether or not the COVID-19 pandemic is responsible for a rise in anti-vaccine legislation.

But, while we wait for those data to come in, this report offers preliminary evidence that the COVID-19 vaccine may be motivating legislators to introduce anti-vaccine legislation.

Although most bills in state legislatures don’t mention a particular vaccine by name, we find that over one third of bills introduced in 2023 in state legislatures across the United States mentioned the COVID-19 vaccine by name; more so than any other type of vaccine SVPP is tracking. Often, those references were quite negative. Most bills referencing the COVID-19 vaccine had an anti-vaccine focus, and nearly half of all anti-vaccine bills introduced in 2023 specifically referenced COVID-19.

A few key top line results:

1. Many Vaccine-Related Bills Introduced in 2023 Mention the COVID-19 Vaccine. While a majority of vaccine-related bills introduced in legislatures across the US make no mention of a specific vaccine (397 bills, 51%), COVID-19 vaccination is mentioned by name in 40% of all vaccine-related bills (290 bills reference COVID-19). That’s more than seasonal flu (97 bills, 12%), measles mumps and rubella (MMR; 37 bills, 5%), and several other vaccines.
2. Nearly Half of Anti-Vaccine Bills Mention COVID-19. Of the 376 anti-vaccine bills introduced in 2023, 176 mentioned the COVID-19 vaccine by name (47%).
3. Most Bills That Mention COVID-19 are Anti-Vaccine in Focus. A majority (61%) of all bills referencing COVID-19 vaccine were classified as being anti-vaccine.

Many Vaccine-Related Bills Introduced in 2023 Mention the COVID-19 Vaccine.

In a previous report, we found that over 800 vaccine-related bills were introduced in state legislatures across the country in 2023. Please see that report for additional information about those findings (and, as always, please consult our technical guide for additional information about how we collect these data).

In this report, we find that a majority of vaccine-related bills introduced in legislatures across the US make no mention of a specific vaccine. Of the 813 bills introduced in 2023, 397 bills — which is slightly more than half (51%) — made no reference to a particular vaccine (typically referencing vaccination in more general terms).

But, among all the vaccines we’re tracking as part of SVPP, COVID-19 stands out. COVID-19 vaccination was mentioned by name in 40% of all vaccine-related bills in 2023.

That’s more than vaccines for seasonal flu (97 bills, 12%), Measles Mumps and Rubella (MMR; 37 bills, 5%), Diphtheria Tetanus and Pertussis (DTaP; 53 bills, 6%), Human Papilloma Virus (HPV; 51 bills, 6%), and Respiratory Syncytial Virus (RSV; 6 bills, <1%). Note that bills could reference multiple vaccines, or none at all, and so percentages may not add up to 100%.

Nearly Half of Anti-Vaccine Bills Mention COVID-19.

In our previous report, we found that anti-vaccine legislation was quite common in state legislatures across the United States in 2023. In this report, we offer preliminary evidence that COVID-19 may be responsible for this development.

We cannot say definitively that anti-vaccine legislation arose as a result COVID-19 pandemic without data that facilitate over-time comparisons.

While that longitudinal data is still being collected, as the COVID-19 vaccine could not have possibly existed prior to the onset of the COVID-19 pandemic, documenting asymmetrically high levels of references to COVID-19 in anti-vaccine bills introduced in 2023 may offer some suggestive data in favor of this view.

That’s precisely what we find. Of the 376 anti-vaccine bills introduced in 2023, 176 mentioned the COVID-19 vaccine by name (47%). That’s more than six-times greater references to COVID-19 vaccines than to vaccines commonly administered in childhood like DTaP and MMR, and 9 times greater than the number of references to the seasonal flu vaccine.

Figure 1 plots the total number of references to each different type of vaccine that SVPP is tracking, across anti- (left) and pro-vaccine (right) bills. As the figure makes clear, COVID-19 is the most commonly mentioned vaccine across both pro- and anti-vaccine bills. But, pro-vaccine bills are less likely to mention any specific vaccine by name (196 out of 372 pro-vaccine bills made no reference to any vaccines), and the asymmetries between COVID-19 vaccine references and those to other types of vaccination is far less extreme.

Figure 1. The Frequency of Pro- and Anti-Vaccine Bills that Reference Different Types of Vaccines

Most Bills That Mention COVID-19 are Anti-Vaccine in Focus.

Of the 290 bills that reference the COVID-19 vaccine, a majority (61%) were classified as being anti-vaccine (176 out of 376 anti-vaccine bills). This stark asymmetry offers even more evidence consistent with the idea that lawmakers’ reactions to the COVID-19 pandemic are responsible for anti-vaccine legislation.

Whether or not anti-vaccine legislation declines over time, as our experiences with the COVID-19 pandemic fade into the background, is an open question. SVPP will be collecting data from state legislatures at the end of the 2024 calendar year to explore this possibility further.

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SVPP consists of Dr. Matt Motta (mmotta@bu.edu) and Dr. Tim Callaghan (timcal@bu.edu). Please contact Dr. Motta with technical questions about this report. Please reach out to us directly for press inquires.

SVPP is funded by a seed grant from the Boston University School of Public Health. We thank Boston University for their generous support. Coders for SVPP include MPH student Emma Mears, and BUSPH MPH alumnus Ali Rivera. This report is made possible by their hard work and dedication to the project, and for that we are immensely thankful.

In this brief report, we assess the state of anti-vaccine policymaking (i.e., bills that aim to undermine vaccination efforts) in the calendar year 2023.

Top line findings include the following:

1. Hundreds of Vaccine-Related Bills Were Introduced Across State Legislatures. State legislatures across the United States introduced 813 vaccine-related bills in 2023.
2. Anti-Vaccine Legislating is Common. Of the 813 bills introduced in 2023, a nearly identical number were classified as pro- vs. anti-vaccine. Whereas 46% (372) were classified as pro-vaccine, a nearly-identical number 46% (N = 376) were classified as anti-vaccine (with 8%, or 65 bills falling into neither category).
3. Republicans were Responsible for Most Anti-Vaccine Legislating. Republican state lawmakers were more likely than Democrats to introduce anti-vaccine legislation. Of the 376 anti-vaccine bills introduced in 2023, 84% (317) were introduced by Republican lawmakers, compared to just 3% (10) by Democrats.
4. Dozens of Anti-Vaccine Bills Were Enacted Into Law. Although a majority of anti-vaccine bills are either pending legislative action (N = 271, 71%) or have been rejected (N = 63, 7%), dozens of anti-vaccine bills from 2023 state legislative sessions (N = 42, 5%) have been enacted into law.

Finding #1: Hundreds of Vaccine-Related Bills Were Introduced Across State Legislatures in 2023

SVPP identified 813 vaccine-related bills that were introduced in state legislatures across the United States from January 1 — December 31 2023. Additional information about how we identified vaccine-related bills can be found in our technical supplement.

As we document in Table 1, New York led the nation with 73 vaccine-related bill introductions. Just 16 of those bills (22%) were classified as being anti-vaccine in focus. Texas, in sharp contrast, introduced the second most (N = 62) vaccine-related bills; 45 (75%) of which were classified as anti-vaccine. With the exception of Delaware, all US states introduced at least one vaccine-related bill in 2023.

Table 1. Vaccine-Related Legislation Introduced Across States in 2023

   State   |   Promote     Oppose    Unclass.|     Total
-----------+---------------------------------+----------
        NY |        52         16          5 |        73 
        TX |        14         45          3 |        62 
        MN |        19         28          6 |        53 
        MS |        33         11          0 |        44 
        IL |        26          9          6 |        41 
        WV |        12         22          2 |        36 
        VA |        24          8          3 |        35 
        IA |        16         12          2 |        30 
        OR |        11         17          2 |        30 
        FL |         8         13          0 |        21 
        MO |         5         10          5 |        20 
        UT |         9          8          3 |        20 
        RI |         4         11          3 |        18 
        NC |         3         13          0 |        16 
        AL |         5          7          3 |        15 
        AZ |         6          7          2 |        15 
        DC |         7          7          1 |        15 
        WA |         8          6          1 |        15 
        OK |         1         13          0 |        14 
        ID |         1         12          0 |        13 
        ME |         4          9          0 |        13 
        PA |         4          8          1 |        13 
        MI |         7          4          0 |        11 
        TN |         2          8          1 |        11 
        VT |         7          3          1 |        11 
        CA |        10          0          0 |        10 
        KY |         5          3          2 |        10 
        MA |         8          1          1 |        10 
        KS |         6          3          0 |         9 
        SC |         3          4          2 |         9 
        WI |         4          4          1 |         9 
        CO |         7          1          0 |         8 
        CT |         3          5          0 |         8 
        NE |         5          2          1 |         8 
        AK |         3          2          2 |         7 
        HI |         4          3          0 |         7 
        MD |         5          2          0 |         7 
        ND |         0          7          0 |         7 
        OH |         0          4          3 |         7 
        GA |         2          4          0 |         6 
        IN |         3          3          0 |         6 
        NH |         2          4          0 |         6 
        NV |         3          2          1 |         6 
        LA |         1          3          1 |         5 
        MT |         2          3          0 |         5 
        AR |         1          3          0 |         4 
        NJ |         3          1          0 |         4 
        NM |         2          1          0 |         3 
        WY |         1          1          1 |         3 
        SD |         0          2          0 |         2
-----------+---------------------------------+----------
     Total |       372        376         65 |       813 

Note. Source = State Vaccine Policy Project. Please review our technical supplement for additional information about data collection and bill subject classification.

Finding #2: Anti-Vaccine Legislation is Common

We also find that “anti-vaccine” bills aiming to undermine vaccine promotion (e.g., by curtailing or eliminating vaccine mandates in different employment or educational settings) are quite common. Of the 813 bills introduced in 2023 a nearly identical number were classified as pro- vs. anti-vaccine. Whereas 46% (372) were classified as pro-vaccine, a nearly-identical number 46% (N = 376) were classified as anti-vaccine (with 8% or 65 bills falling into neither category).

Again, please see our technical supplement for additional information on how we classified bills as pro-vaccine vs. anti-vaccine.

Figure 1 provides additional information about the subject of anti-vaccine bills introduced across state legislatures. The figure plots the number of bills that aim to weaken vaccine mandates in five areas: health care settings (e.g., hospitals), government offices, private businesses, students attending public schools, and educators working in public schools.

We find that nearly a third (N = 117, 31%) of anti-vaccine bills introduced in 2023 take aim at weakening vaccine mandates for children attending public schools, while over a quarter (N = 97, 26%) aim to weaken vaccine mandates in private employment settings. Few bills take aim at weakening vaccine mandates in health care settings, or for educators who work in public schools.

Figure 1. The Number of Anti-Vaccine Bills Introduced that Aim to Weaken Vaccine Mandates in Different Settings.

Note. Source = State Vaccine Policy Project. Please review our technical supplement for additional information about data collection and bill subject classification.

Finding #3: Republicans are Responsible for Most Anti-Vaccine Legislating

The overwhelming majority of anti-vaccine bills introduced across state legislatures in 2023 were sponsored by members of the Republican Party. Figure 2 plots the count (left-hand panel) and proportion (right-hand panel) of anti-vaccine bills introduced by Democrats and Republicans in 2023. It also displays bills introduced by Independents, or which were co-sponsored by both Republicans and Democrats (“Bi-Partisan.”)

We find that, of the 376 anti-vaccine bills introduced in 2023, 84% (317) were introduced by Republican lawmakers, compared to just 3% (10) by Democrats. The 317 anti-vaccine bills introduced by Republicans represented a significant portion of their vaccine-related legislative workload; comprising 69% of all vaccine-related legislation introduced by members of the GOP. Democrats, on the other hand, introduced nearly two hundred (N = 195) bills that aimed to promote vaccination.

Figure 2. The Count (Left) and Proportion (Right) of Pro- vs. Anti-Vaccine Legislation Introduced in 2023, by Sponsor Party Affiliation

Note. Source = State Vaccine Policy Project. Please review our technical supplement for additional information about data collection and bill subject classification.

Finding #4: Most Anti-Vaccine Legislation Does Not Pass, but Dozens of Anti-Vaccine Bills Have Been Enacted Into Law

Finally, we find that although most anti-vaccine legislation is not ultimately passed into law, a concerning number of anti-vaccine bills were adopted by state legislatures in 2023.

Figure 3 plots the count (left-hand panel) and proportion (right-hand panel) of bills introduced at different stages of the legislative process: from whether they have been introduced (with no further action), referred to committee, advanced from committee, or adopted into law. We also provide information about whether bills were not adopted (rejected) in the state legislature.

The figure suggests that a majority of anti-vaccine bills introduced in 2023 are either pending legislative action (N = 271, 71%) or have been rejected (7%, N = 63). Worryingly, though, dozens of anti-vaccine bills (N = 42, 5% of all bills introduced) have been enacted into law. Anti-vaccine bills consist of nearly 30% (N = 42) of the 141 vaccination bills adopted into law by state legislatures in 2023.

Pro-vaccine bills, on the other hand, were somewhat more likely to be enacted into law (N = 84, 10% of all bills introduced). But, most pro-vaccine legislation remains pending further legislative action.

Figure 3. The Count (Left) and Proportion (Right) of Pro- vs. Anti-Vaccine Legislation Introduced in 2023, by Legislative Progress

Note. Source = State Vaccine Policy Project. Please review our technical supplement for additional information about data collection and bill subject classification.

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SVPP consists of Dr. Matt Motta (mmotta@bu.edu) and Dr. Tim Callaghan (timcal@bu.edu). Please contact Dr. Motta with technical questions about this report. Please reach out to us directly for press inquires.

SVPP is funded by a seed grant from the Boston University School of Public Health. We thank Boston University for their generous support. Coders for SVPP include MPH student Emma Mears, and BUSPH MPH alumnus Ali Rivera. This report is made possible by their hard work and dedication to the project, and for that we are immensely thankful.

In December 2023, the Politics & Health Lab (PHL) at Boston University’s School of Public Health (BUSPH) launched the State Vaccine Policy Project (SVPP). SVPP’s goal is to track all vaccine-related legislation introduced across state houses in the United States from the mid-1980s to the present day.

Data from SVPP will allow us to monitor changes in vaccine legislating over time. With SVPP data, we can answer questions like:

Are “anti-vaccine” bills (e.g., bills that aim to undermine vaccine mandates, reduce the resources available for vaccinating, etc.) becoming more common over time?

How many anti-vaccine bills are actually passed into law in each state and in each legislative session?

Are some types of legislators (on the basis of geography, political party, etc.) more likely to introduce anti-vaccine legislation than others?

Dr. Matt Motta and Dr. Timothy Callaghan are SVPP’s Principal Investigators.

The project plans to release a brief report on The State of Anti-Vaccine Policymaking in the 2023 Legislative Session in early October 2024. Through the coming months, the team plans to release additional reports that contrast findings from 2023 to findings from years prior, and that unpack the focus, history, and public health consequences of anti-vaccine bills that have been enacted into law.

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SVPP consists of Dr. Matt Motta (mmotta@bu.edu) and Dr. Tim Callaghan (timcal@bu.edu). Please contact Dr. Motta with technical questions about each report. Please contact us directly for press inquires.

SVPP is funded by a seed grant from the Boston University School of Public Health. We thank Boston University for their generous support. Coders for SVPP include MPH student Emma Mears, and BUSPH MPH alumnus Ali Rivera. This work is made possible by their hard work and dedication to the project, and for that we are immensely thankful.